Don’t sugarcoat this. Trump just called for 32 million people to lose health coverage.

President Trump’s profound ignorance about policy and the inner workings of our system, and his total disinterest in informing himself about these topics, have produced an unfortunate result: Many of his tweets about matters of substance tend to get ignored as Trump just being Trump. Meanwhile, the viscerally disgusting insults (such as the one claiming Mika Brzezinski bled from her face-lift) make international news.

But Trump’s tweet this morning about health care actually does matter, a lot:

If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!

This is getting a lot of attention today, but mainly as a call for Republicans to adopt a particular legislative strategy. As such, it makes little sense: Republicans are struggling to find 50 votes for their current repeal-and-replace bill, with many moderates balking, so it’s hard to see how outright repeal could get a bare majority.

Beyond this, though, it’s worth taking Trump’s tweet as an actual policy statement. Trump has now called for total repeal of the Affordable Care Act, with no guarantee of any specific replacement later, or even a guarantee that any replacement would ever materialize at all.

The Republicans' time-crunched effort to pass a health-care bill stalled in the Senate over the summer, but now some of the GOP hopes to push another plan forward. The Post's Paige Cunningham explains five key reasons the party is struggling to move their plan forward. (Jenny Starrs/The Washington Post)

It’s hard to estimate what would happen if Republicans did act on this and Trump signed it. Republicans probably wouldn’t be able to repeal some key portions of the Affordable Care Act — particularly its insurance-market regulations — via a simple majority “reconciliation” vote. But they could theoretically repeal things with a budgetary orientation, such as the individual mandate and the Medicaid expansion and the subsidies to lower-income people why buy insurance on the exchanges.

We can estimate the impact of repealing those things. Indeed, the Congressional Budget Office has already done so, when it analyzed a previous version of a GOP repeal bill over a year ago. And that analysis found that repealing those things would result in 32 million people losing coverage by 2026, 19 million of them people who would lose Medicaid coverage.

President Trump and his advisors claim spending for Medicaid will continue to increase under the Senate health-care proposal. CBO projections suggest otherwise. (Meg Kelly/The Washington Post)

This is unequivocally what Trump has now called for. And it is substantially worse than what is currently being debated in the Senate, which would result in 22 million people losing coverage over 10 years, 15 million of them from Medicaid, per the CBO.

“When Republicans floated their repeal bill back in 2016, CBO concluded that 32 million people would lose coverage, relative to the current baseline, by 2026,” Nicholas Bagley, a health policy expert at the University of Michigan, emailed me today. “Fully 19 million people would be kicked off of Medicaid. Those coverage losses are even grimmer than the losses from the House and Senate bills that are currently under discussion.”

Whether Trump meant this or not, or even knew what he was calling for, are irrelevant. That’s because it could theoretically happen. In fact, conservative senators such as Rand Paul of Kentucky and Ben Sasse of Nebraska are actively calling on fellow Republicans to go forward with repeal alone right now. Sasse doubled down by tweeting an endorsement of Trump’s demand.

Trump, it pains me to inform you, is the president. When he calls on Congress to do something, he is basically saying that he would sign it if they did do it. There is no reason to treat this as trivial or frivolous simply because Trump is an ignoramus and a buffoon. Indeed, Republicans have in fact voted for repeal multiple times in the past. The only reason they aren’t doing so right now is because repeal cannot pass, now that there is a Republican in the White House who would actually sign such a bill. (Yes, Trump would sign such a bill in two seconds. He called for one today, remember?)

In this sense, Trump’s tweet is actually kind of useful. It reveals once again that Republicans have been running a massive scam on Obamacare for years. They constantly fulminated for repeal, and voted repeatedly for it, in the full knowledge that President Barack Obama would veto it and that they would not face the consequences of their rhetoric and vote. The promise of unspecified replacements allowed Republicans to claim they would act to make sure millions didn’t lose coverage, without saying how. But now that repeal could become a reality, they are no longer willing to vote for it, because they would be held accountable for those consequences. By calling for straight-up repeal right now, Trump has inadvertently called their bluff.

Indeed, it’s not even clear that Senate Republicans can pass repeal and replace, because it has become obvious that even this would result in many millions losing health coverage, extracting an immense human toll that is now a genuine possibility. Moderate Republican senators have conceded this to be the case, and their seemingly genuine qualms about this constitute a pleasant surprise. But Republicans who have no serious misgivings about such an awful outcome have resorted, for political reasons, to all manner of lies and obfuscation to obscure this reality.

This includes Trump and the White House, who have dissembled relentlessly about how their plan would leave everybody covered and wouldn’t cut Medicaid at all. But now Trump has confirmed that he is indeed for full repeal, full stop — which would result in 32 million fewer covered — without any guaranteed “replacement” providing any cover to advance the lie that millions wouldn’t lose coverage. Trump has unmasked his own scam.

“It’s not equitable to have a situation where you’re increasing the burden on lower-income citizens and lessening the burden on wealthy citizens. That’s not a proposition that is sustainable, and I think leadership knows that.”

That’s nice, but there is no way the final bill will not do this to a great extent, even if they throw a bit more spending into it. Yet Corker will still vote “yes” in the end.

More than 75% of those present … were adamantly opposed, arguing it was bad economics and bad global politics. At one point, Trump was told his almost entire cabinet thought this was a bad idea. But everyone left the room believing the country is headed toward a major trade confrontation. The reason, we’re told: Trump’s base — which drives more and more decisions, as his popularity sinks — likes the idea, and will love the fight.

We’ll find out soon enough how real this is, but for now, the disturbing thing is that it is perfectly plausible that this actually is the “thinking.”

* DEBUNKING WHITE HOUSE NONSENSE ABOUT MEDICAID: Trump and the White House like to say that the health bill wouldn’t actually “cut” Medicaid, because spending would still rise more slowly. Michelle Ye Hee Lee sets the record straight:

In 2017, the federal government spent $393 billion on Medicaid. If no change is made to the current law, that spending is expected to be $624 billion by 2026. The CBO calculates this by taking several factors into account, such as projected enrollment growth, health-care costs, inflation, population growth and policies that states may enact. … But things would change under the Senate bill. Instead of Medicaid spending growing to $624 billion by 2026, it would be $464 billion — a difference of $160 billion in 2026. This means a reduction of $772 billion over 10 years, from 2017 to 2026.

It’s amazing that what the White House claims is not a cut would somehow result in 15 million fewer people on the program, isn’t it?

Trump and Congress have a lot on their plate before their summer recess in August — raising the debt limit, passing a budget, moving on tax reform. It’s a daunting agenda during the best of times. And it’s much, much harder with a distracted president, a commander-in-chief whose approval rating is in the 30s and 40s.

Because Republicans spent almost the entire Obama administration railing against the imaginary horrors of the Affordable Care Act — death panels! — repealing Obamacare was bound to be their first priority. Once the prospect of repeal became real, however, Republicans had to face the fact that Obamacare, far from being the failure they portrayed, has done what it was supposed to do: It used higher taxes on the rich to pay for a vast expansion of health coverage. Correspondingly, trying to reverse the A.C.A. means taking away health care from people who desperately need it in order to cut taxes on the rich.

* JOE AND MIKA HIT BACK: Joe Scarborough and Mika Brzezinski write a joint op-ed hitting back at Trump’s claim that Brzezinski was “bleeding badly from a face-lift,” claiming that the face-lift never happened and that Trump “is not well.” Note this:

The president’s unhealthy obsession with our show has been in the public record for months … This year, top White House staff members warned that the National Enquirer was planning to publish a negative article about us unless we begged the president to have the story spiked. We ignored their desperate pleas.

It’s hard to know what’s stranger about this anecdote — the suggestion that White House staffers made this warning or the claim that they demanded a show of groveling to the president.